Heddy Dale- Matthiashttp://northsidesun.com/taxonomy/term/209/0
enKudos to Telehealth Centerhttp://northsidesun.com/opinion-columns/kudos-telehealth-center
<div class="field field-name-field-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><img src="http://northsidesun.com/sites/northsidesun.com/files/styles/large/public/field/image/Heddy%20Matthias%202013_0.jpg?itok=XlRjFd4t" width="576" height="288" alt="" /></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"> <p>I was recently fortunate to visit University of Mississippi Medical Center’s Center for Telehealth. Michael Adcock, the recently appointed administrator, gave me a thorough tour and interview explaining in detail the various aspects of the program. It was an astonishing experience.</p>
<p>I knew little about the center, other than a few articles I had seen in local papers. I work for a telemedicine company myself, and was curious about the program at UMMC. Additionally, the Mississippi Legislature was debating the telemedicine bill at the time.</p>
<p>Unlike many practicing physicians in the state, I am a hospital-based physician without a clinic. For better or worse, the daily difficulties of running a clinic, especially in a rural area of this state, do not constitute my life.</p>
<p>However, I encounter many rural patients, especially in my anesthesia practice at the Jackson Eye Institute with Dr. James Bruce, performing cataract surgeries. For more than 20 years, I have been very frustrated in dealing with the many medical problems of this elderly population, many of whom are poor and African-American with a myriad of the usual problems of poorly controlled hypertension, diabetes, renal disease, and cardiovascular disease. The poor control of these problems has led me to many over-the-phone conversations with the patients’ primary and specialty-care physicians.</p>
<p>Diabetes control and education are the most difficult problems, which, I suspect, comes as no surprise to my colleagues.</p>
<p>That’s why I was especially interested and impressed with UMMC’s Telehealth Center’s programs in diabetes, cardiovascular care, dermatology, and mental health.</p>
<p> </p>
<p>The Telehealth center’s diabetes program, which has already demonstrated its ability to save millions of dollars in healthcare costs, enrolls diabetic patients at the request of their primary care physician. After this, the patients are given a HIPAA-compliant tablet, record their blood sugars, etc., and are followed on a daily and monthly basis by a team of diabetic nurses. In turn, these nurses call or video the patients when problems appear, coach the patients, and call the primary care physician with their findings and discuss problems, recommendations, and solutions. The center also runs the same types of programs with tablets and electronic scales that can follow premature neonates as they return home to distant areas, with the same offerings of nurse monitoring and consultations, with ultimate reporting to the patients’ physicians.</p>
<p>The center has elaborate video-conferencing direct to many rural emergency rooms, providing real-time patient assessments by on-call physicians, and immediate recommendations for the treatment of stoke, myocardial infarction, and other acute illnesses that a rural hospital might not treat on a routine basis, offering state-of-the-art medical care to these areas.</p>
<p>In the emergency rooms, the center has placed “free of cost” teleportals that allow video conferencing, transmission of heart sounds, and face-to-face videos of the patients and providers. This direct face-to-face is vitally important, as we physicians know “a picture is worth a thousand words.” The ability to transmit the face-to-face audiovisual transmission became a significant center of the battle in this year’s legislative battle, with the Mississippi Board of Medicine and Mississippi State Medical Association’s insistence that audio-only medical care was the sine qua non of the standard of care for licensing of a telemedicine company in the state.</p>
<p> </p>
<p>Mr. Adcock, who has many years experience as a pediatric critical care nurse, hospital administrator, and telemedicine administrator and innovator, was gracious in demonstrating other important programs available to any requesting Mississippi physician.</p>
<p>Imagine that a primary care physician (PCP) wishes to have his/her cardiac patients seen and interviewed once a month by a cardiologist and that his/her recommendations and assessments can be discussed directly with the PCP. Imagine the same convenience for a PCP by having all his/her patients with skin lesions seen via video-conferencing, or video-transmission of worrisome potential skin cancers. The center can set up these programs right in the PCPs office, avoiding long travel and long wait times for patients. The center can also provide off-site “hospitalist” services to small hospitals unable to afford their own in-house physicians, thereby offering care in a cost-effective manner to rural hospitals and patients in real time.</p>
<p>The center has an in-house staff of highly trained and experienced critical care nurses who spend 8-10 hours a shift monitoring multiple patients in UMMC’s many critical care units, using highly-advanced and technical software programs that allow monitoring of critical events and trends and oversight of these patients, trends and events that might have been overlooked by their primary physician and nurse, allowing early interventions and solutions.</p>
<p>Mr. Adcock was clear in the center’s mission: to provide advanced, convenient, cost-effective medical care, monitoring, and consultation to areas of Mississippi that are underserved in order to improve the overall health of the state. He was adamant that the center was not interested in obtaining new patients for UMMC or siphoning patients from PCPs in the state. Rather, he assured me that UMMC wished to help provide PCPs/specialists and their patients the most convenient, cost-effective, and “best practices” medicine no matter where they worked, lived, or practiced.</p>
<p> </p>
<p>The center has some “for-profit” services in order to sustain the “not-for- profit” aspect of its other programs. They supply video-conferencing portals for private corporations in and out of Mississippi for out-patient services. They comply with the face-to-face requirements suggested by the Legislature, MSBML and MSMA.</p>
<p>I admit that prior to my visit I was skeptical of the center for telemedicine. I, as I suspect many other physicians, thought it might be a political organization bent on a mission of consolidating UMMC’s control of medical services in the state. However, Mr. Adcock’s detailed interview assured me this is not the case, but that rather it is providing the best of what a university medical center can do for a community: provide a cost-effective, convenient, state-of-the-art program to extend medical expertise to any requesting physician in Mississippi and Mississippi’s citizens.</p>
<p>I suggest that my colleagues learn more about the center, avail themselves of its services for themselves and their patients, and ask them how they can help. The future possibilities are unlimited in what the center can do to improve healthcare for the state.</p>
<p>Kudos to the Center for Telemedicine.</p>
</div></div></div><div class="field field-name-field-section field-type-taxonomy-term-reference field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/opinion"><span>Opinion</span></a></div><div class="field-item odd"><a href="/columns"><span>Columns</span></a></div></div></div><div class="field field-name-event-calendar-date field-type-datetime field-label-above"><div class="field-label">Date:&nbsp;</div><div class="field-items"><div class="field-item even"><span class="date-display-single">Friday, July 15, 2016 - 10:15</span></div></div></div>Fri, 15 Jul 2016 15:23:38 +0000wmccain2665 at http://northsidesun.comMy immigration journeyhttp://northsidesun.com/columns/my-immigration-journey
<div class="field field-name-field-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><img src="http://northsidesun.com/sites/northsidesun.com/files/styles/large/public/field/image/Heddy%20Matthias%202013.jpg?itok=TmeMrkH4" width="576" height="633" alt="" /></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"> <p>I’m not certain when I first met Sofia, or how I came to know her. She has been my once-a-week housekeeper for around five years. She is paid well and does a good job, including my laundry. My house is large, multileveled, uncluttered, and mostly unused. My Golden Retriever, Luka, adds his abundant shedding blonde hair to her labors.</p>
<p> Sofia usually cleans alone, but sometimes her mother, Emma, accompanies her to help. Sofia is 24, and her mother, Emma, is 55. Sofia has a three-year-old daughter, Elisa Cruz, who was born in the United States. Sofia was three when her mother brought her and her five-year-old sister, Fernanda, to the U.S. Although her mother was here legally on a visa for a while, she sent for Sofia and her sister after their father died in Mexico and the girls entered the U.S. without authorization. </p>
<p>According to Sofia, her father was a well-to-do attorney in Mexico. She says that his siblings were able to finesse the legal system in Mexico to garner the bulk of his estate, leaving his immediate family with nothing but their house. Emma sold the house and came to the U.S. on a visa, and subsequently brought her two daughters here. </p>
<p> Emma entered into a new live-in relationship in Mississippi and her partner became a stepfather, of sorts, to her children. However, Emma’s partner proved to be an unfit alcoholic, and frequently assaulted her. At that time, Emma consulted Patricia Ice, an immigration attorney in Jackson. By this time Emma had overstayed her authorized time limit in the United States and she was living with expired immigration documents in Mississippi. Ms. Ice was able to help convince the United States Citizenship and Immigration Services (USCIS), a unit of the Department of Homeland Security, to allow Emma to stay legally in this country after the conviction, arrest, and deportation of her abusive partner. </p>
<p> </p>
<p>Emma is now a lawful permanent resident. She would one day like to become a citizen, but she must wait five years before she can even apply. After that she must wait a few more months to pass naturalization tests and take the oath of allegiance.</p>
<p> Because Sofia and her sister came into this country without authorization, they were in undocumented status for a long time. For that reason, they were unable to visit relatives in Mexico. Of course, since they are Mexican citizens, they could go to Mexico at any time. But they would not have been able to return to the United States. The girls were students in school in metro Jackson and their mother had made a life for them here. Leaving would have disrupted everything they had all worked for. </p>
<p>In June 2012 President Barack Obama issued an executive order called the Deferred Action for Childhood Arrivals (DACA) program. Pursuant to this executive order Sofia was able to get an employment authorization card from the USCIS for two years with an option to renew. Although she continues to have permission to work here, according to USCIS, Sofia has no immigration status, but is considered lawfully present in the U.S. If this sounds confusing, it is. Her sister, Fernanda, has U Nonimmigrant status because she, too, like her mother, was a victim of severe domestic violence. </p>
<p> I thought, until recently, that Sofia was married to the father of her daughter, but she is not. She was vague when I asked her why she wasn’t, and suggested that they wanted to marry in Mexico, but couldn’t return there at this time. The father of her daughter, Elisa Cruz, is undocumented in the U.S., and works for cash for his brother who runs a framing crew in the Jackson area. I suspect they cannot marry here because of his unauthorized status.</p>
<p> Sofia is presently enrolled at Hinds Community College in a paralegal program, and, according to her, receives “straight A” grades. Since Sofia does not have lawful permanent residence status, she must pay almost twice the tuition that American citizen students pay to attend Hinds. This is a cruel irony because Sofia attended and graduated from public elementary, middle and high schools in Mississippi like most of her community college classmates. </p>
<p>As a result of the U.S. Supreme Court case Plyler v. Doe (1982) all children, regardless of immigration status, have the constitutional right to attend U.S. public K-12 schools. The Mississippi Immigrants Rights Alliance (MIRA), where Patricia Ice is the legal project director, in collaboration with other organizations, is actively advocating for tuition equity, which would allow undocumented college students who attended high school in Mississippi to pay the same tuition as permanent resident and American citizen students.</p>
<p>Earlier this year during the regular Mississippi state legislative session, a state representative introduced a bill for tuition equity. The committee chair refused to bring the bill to a vote; therefore, it did not move forward. According to the National Conference of State Legislatures, 20 states offer in-state tuition to post-secondary unauthorized immigrant students. <a href="http://www.ncsl.org/research/immigration/tuition-benefits-for-immigrants.aspx">http://www.ncsl.org/research/immigration/tuition-benefits-for-immigrants...</a></p>
<p> When Sofia is finished with her paralegal studies, she plans to attend Jackson State University to compile credits to apply for law school; her ultimate goal is to become an attorney like her father. I have told her I would do anything possible to help her fulfill her dream. Sofia is uncertain whether she’d like to practice law in the U.S. or Mexico.</p>
<p>As long as Sofia remains unmarried, her mother, Emma, as a lawful permanent resident or a U.S. citizen, can petition for Sofia to also become a permanent resident. However, after the petition is filed, Sofia could wait up to 21 years to become a permanent resident. Her sister Fernanda’s “U Nonimmigrant status” allows her to apply for lawful permanent residence this year.</p>
<p> </p>
<p>Sofia told me that she is ambivalent about whether she wants to become a U.S. citizen and remain here, or, at some time in the future, return to Mexico. If she ever becomes a U.S. citizen, according to current policy, Sofia can also keep her Mexican citizenship. </p>
<p>I asked her why she remains here and doesn’t return to Mexico now. She replied, “Presently, there is no work for me in Mexico, and I couldn’t make the type of money that I and my family make here. If I returned to Mexico now, I probably would have to wait at least five years to re-enter the U.S. to see my mother. In addition, I left Mexico when I was three and I don’t have a home there, nor do I know anything about Mexico, although I would like to see my relatives and extended family.”</p>
<p> I have grown to love and admire Sofia and her mother. I trust them both with the keys to my house and everything in it. Most of the time no one is in the house, or even in town, when she comes to clean. When I broke my femur last year and was depressed and disconsolate about being in a wheelchair and confined to one room in my house for six months, Emma would often volunteer to stay overnight to keep me company and lighten my spirits. She would often pray for my recovery. Sofia and Emma both are lovely, kind, intelligent, spiritual, and, especially, hard-working women.</p>
<p> Why have I taken the time to write about Sofia and Emma?</p>
<p> Prior to knowing them, and, actually, until recently, I have been a severe “hard-liner” on illegal immigration, especially Hispanic immigration from Mexico. I have often said, “I love immigrants. My father was a German Jew who was fortunate to immigrate here prior to the Nazi takeover of Germany, before Kristallnacht in 1938, before the SS began spying on everyone, and before the concentration camps began operations, incinerating some of my relatives. But our country should welcome all immigrants equally, irrespective of geography. Mexicans should not have a ‘leg up’ because of the serendipity of their geography. Immigrants must come here legally, in an orderly fashion, and from countries far and wide. Immigrants must be fully vetted prior to acceptance. And those who choose to walk across bridges, or swim rivers, or be shuttled in dark vans should not then or now be able to become citizens ahead of others who legally apply for citizenship.”</p>
<p> </p>
<p>I still do believe that quote. I do, but………. What are we to do with all the Sofias and Emmas in this country? Sofia knows nothing of Mexico, as she’s been raised and schooled here her whole life. Her daughter, Elisa Cruz, is a three-year-old U.S. citizen. Sofia did not come here to have a child. She had a child in the same fashion and for the same reasons as most U.S. women do after living here for the entirety of her adult life. As a U.S. citizen, Elisa Cruz receives Medicaid and SNAP like many other Mississippi children of hard-working parents. </p>
<p>Sofia and her family emulate all the qualities we desire in our citizens - strong family relations, spirituality, endurance, perseverance, sobriety, and high educational achievement.</p>
<p>Am I still concerned about the porosity of our borders? Absolutely yes. Am I adamant that the U.S. must control its borders and immigration process? Yes. Am I angry that the federal government has allowed unauthorized and seemingly unlimited immigration for at least three decades? Yes. But my experience with Sofia, Emma, and Elisa Cruz have moderated and nuanced my understanding of the complexities of “illegal immigration” by putting human faces on the problem.</p>
<p>Or, perhaps, I’m just getting to be a “softie” in my old age…</p>
<p>Note: The women in this article are compellations of many undocumented immigrants. All names and facts have been altered in protection.</p>
<p>Heddy Dale-Matthias is a Northsider.</p>
</div></div></div><div class="field field-name-field-section field-type-taxonomy-term-reference field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/columns"><span>Columns</span></a></div></div></div>Fri, 02 Oct 2015 15:36:01 +0000nhodum1268 at http://northsidesun.com